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Portal Venous Resection in Cancer of the Pancreatic Head: What Are the Relevant Predictors of Survival?
Hryhoriy Lapshyn*1, Ulrich F. Wellner2, Birte Kulemann1, Jens Hoeppner1, Peter Bronsert3, Dirk Bausch2, Ulrich T. Hopt1, Frank Makowiec1, Tobias Keck2, Uwe a. Wittel1
1Clinic for general and visceral surgery, University of Freiburg Medical Center, Freiburg im Breisgau, Germany; 2Clinic for general and visceral surgery, University Hospital Schleswig-Holstein-Campus Luebeck, Luebeck, Germany; 3Institute of Pathology, University of Freiburg medical Center, Freiburg im Breisgau, Germany
Introduction:
When tumors are found to be adherent to the superior mesenteric or portal vein during pancreatoduodenectomy, en bloc portal venous resection (PVR) is an option to achieve complete tumor resection. It has also been reported that PVR without confirmed histopathologic portal venous infiltration (PVI) is associated with significantly better survival. The aim of this study was to evaluate oncologic outcome and prognostic factors in patients receiving PVR for pancreatic cancer.
Methods:
A unicenter retrospective study was performed on the basis of a prospectively maintained database. IBM SPSS Version 21 was used for all calculations with the significance level set to p=0.05.
Results:
From 2001 to 2013, 103 patients received pancreatoduodenectomy with PVR for pancreatic head cancer. Median survival in patients with PVR without PVI was 25 months, whereas confirmed PVI was associated with poor median survival of 14 months (p<0.05). In patients with PVR, only PVI and lymph node ratio, but not margin status, T or N stage, grading, lymphatic, microvessel or perineural infiltration, age or gender were independent prognostic factors in a multivariate Cox proportional hazards model.
Conclusion:
Portal venous resection for tumor adherence in pancreatic cancer is associated with equal median survival as in patients without PVR when there is no histopathologic infiltation of the large veins. Additional prognostic information is only provided by lymph node ratio, whereas margin status and other standard histopathologic parameters have no additional predictive value in this situation.
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